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Identify documentation gaps and increase your risk capture

Physicians are trained to document patient care and bill for procedures, not to pay attention to details required for diagnosis coding. On average, we find over 20% of retrieved charts for Medicare Advantage risk adjustment retrospective review contain a documentation gap. Closing these gaps means better capture of disease burden and more accurate risk adjustment payments from CMS.

Missing documentation is hurting your risk adjustment accuracy

Physicians who treat MA patients often fail to capture all the elements required for risk adjustment coding. Commonly missing information includes:

  • Physician signature
  • Unclear date of service
  • Supporting treatment plan for the patient’s condition

These data gaps can have a negative impact on risk capture, HCC-related reimbursements, and patient care quality.

Clinical documentation for risk adjustment

Documentation Gaps: The fastest way to improve condition capture in encounter notes

Apixio’s Documentation Gaps solution uses machine learning algorithms to analyze member charts and identify encounter notes with attributed HCCs lacking critical documentation elements required for CMS submission. Each gap is attributed to a provider and includes the missing elements and the encounter date of service. Equipped with intelligence on documentation gaps, your organization can:

  • Improve capture of patient conditions in charts for risk adjustment
  • Educate physicians to improve their documentation practices
  • Fix missing documentation to secure in-year condition capture & payment

Fast Facts

0 %
Charts with clinical documentation gaps
0 %
Medicare payments lacking sufficient documentation
$ 0 Billion
Annual value of submitted claims without sufficient evidence
Improve your diagnosis capture with reliable AI analytics.